Key result
Moderate-to-severe right ventricular dysfunction was associated with increased mortality in ischaemic cardiomyopathy (aHR 1.75; 95% CI 1.40-2.19), with no added survival benefit from CABG.
Why the study?
Whether the presence or evolution of right ventricular dysfunction affects prognosis and the choice between CABG or medical therapy alone in ischaemic cardiomyopathy remains unclear.
Does coronary artery bypass grafting improve all-cause mortality compared to medical therapy alone in patients with ischaemic cardiomyopathy and right ventricular dysfunction?
Cohort (n=1,042)
Does coronary artery bypass grafting improve all-cause mortality compared to medical therapy alone in patients with ischaemic cardiomyopathy and right ventricular dysfunction?
In patients with ischemic cardiomyopathy, right ventricular dysfunction is associated with increased mortality, and CABG does not provide a survival benefit over medical therapy in those with moderate-to-severe RVD.
OBJECTIVES: Whether the presence or evolution of right ventricular dysfunction (RVD) affects the prognosis and the therapeutic choice between coronary artery bypass grafting (CABG) or medical therapy alone in patients with ischaemic cardiomyopathy (ICM) remains unclear. We investigate the prognostic and therapeutic implications of RVD in patients with ICM. METHODS: Patients with baseline echocardiographic right ventricular (RV) assessment were included from the Surgical Treatment of Ischaemic Heart Failure trial. The primary outcome was all-cause mortality. RESULTS: Of 1212 patients enrolled in the Surgical Treatment of Ischaemic Heart Failure trial, 1042 patients were included, with 143 (13.7%) mild RVD and 142 (13.6%) moderate-to-severe RVD. After a median follow-up of 9.8 years, compared with patients with normal RV function, patients with RVD had a higher risk of mortality [mild RVD: adjusted hazard ratio (aHR) 1.32; 95% confidence interval (CI) 1.06-1.65; moderate-to-severe RVD: aHR, 1.75; 95% CI 1.40-2.19]. Among patients with moderate-to-severe RVD, CABG provided no additional survival benefits compared to medical therapy alone (aHR: 0.98; 95% CI: 0.67-1.43). Among 746 patients with pre- and post-therapeutic RV assessment, a gradient risk for death increased from patients with consistent normal RV function, to patients with recovery from RVD, new-onset RVD and persistent RVD. CONCLUSIONS: RVD was associated with a worse prognosis in patients with ICM, and CABG provided no additional survival benefits to patients with moderate-to-severe RVD. The evolution of RV function had important prognostic implications, which emphasized the importance of both pre- and post-therapeutic RV assessment.
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Zhou et al. (2023) conducted a cohort in Ischaemic cardiomyopathy (n=1,042). Right ventricular dysfunction vs. Normal RV function was evaluated on All-cause mortality (aHR 1.75, 95% CI 1.40-2.19). Moderate-to-severe right ventricular dysfunction was associated with increased mortality in ischaemic cardiomyopathy (aHR 1.75; 95% CI 1.40-2.19), with no added survival benefit from CABG.
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